两种固定方式下前外侧入路治疗Rüedi-AllgöwerⅡ型Pilon骨折的疗效比较

Clinical effect of two fixation methods by anterolateral approach in the treatment of Rüedi-AllgöwerⅡPilon fracture

目的探讨一期清创联合外固定、二期序贯内固定治疗Rüedi-AllgöwerⅡ型Pilon骨折的疗效。方法回顾性分析2017年1月至2019年12月浙江省衢州市人民医院36例Rüedi-AllgöwerⅡ型Pilon骨折患者的临床资料。其中,采用一期清创跟骨牵引、二期切开复位内固定治疗16例(内固定组),一期清创联合外固定、二期序贯内固定治疗20例(联合固定组),比较两组手术时间、术中出血量、术后引流量、完全负重时间、骨折愈合时间、美国足踝外科协会(AOFAS)踝后足功能评分、疼痛视觉模拟评分(VAS)、复位质量(Burwell-Charnley评分)和并发症发生率等指标。结果患者随访6~18(10.7±2.8)个月。联合固定组完全负重时间和骨折愈合时间明显短于内固定组[(7.2±1.9)周比(9.4±2.1)周和(3.4±0.8)个月比(4.1±1.2)个月],差异有统计学意义(P<0.05或<0.01);两组手术时间、术中失血量和术后引流量比较差异无统计学意义(P>0.05)。两组术后1个月AOFAS踝后足功能评分比较差异无统计学意义(P>0.05);联合固定组术后3和6个月AOFAS踝后足功能评分明显高于内固定组[(86.4±1.7)分比(75.7±1.2)分和(93.6±2.2)分比(82.1±1.9)分],差异有统计学意义(P<0.05)。两组VAS比较差异无统计学意义(P>0.05)。两组复位满意率和并发症发生率比较差异无统计学意义(P>0.05)。结论一期清创联合外固定、二期序贯内固定治疗Rüedi-AllgöwerⅡ型Pilon骨折利于患者快速恢复。

Objective To investigate the clinical effect of primary debridement combined with external fixation and secondary sequential internal fixation in the treatment of Rüedi-AllgöwerⅡPilon fracture.Methods The clinical data of 36 patients with Rüedi-AllgöwerⅡPilon fracture from January 2017 to December 2019 in the People′s Hospital of Quzhou City,Zhejiang Province were retrospectively analyzed.Among them,16 patients were treated with primary debridement with calcaneal traction and secondary internal fixation(internal fixation group),and 20 patients were treated with primary debridement combined with external fixation and secondary sequential internal fixation(combined fixation group).The operative time,intraoperative blood loss,postoperative drainage volume,time of full weight bearing,fracture healing time,American Society of Foot and Ankle Surgery(AOFAS)posterior ankle foot function score,visual analogue score(VAS),reduction quality(Burwell-Charnley score)and incidence of complication were compared between 2 groups.Results The patients were followed up for 6 to 18(10.7±2.8)months.The time of full weight bearing and fracture healing time in combined fixation group were significantly shorter than those in internal fixation group:(7.2±1.9)weeks vs.(9.4±2.1)weeks and(3.4±0.8)months vs.(4.1±1.2)months,and there were statistical differences(P<0.05 or<0.01);there were no statistical differences in operative time,intraoperative blood loss and postoperative drainage volume between 2 groups(P>0.05).There was no statistical difference in AOFAS posterior ankle foot function score 1 month after surgery between 2 groups(P>0.05);the AOFAS posterior ankle foot function score 3 and 6 month after surgery in combined fixation group was significantly higher than that in internal fixation group:(86.4±1.7)scores vs.(75.7±1.2)scores and(93.6±2.2)scores vs.(82.1±1.9)scores,and there was statistical difference(P<0.05).There was no statistical difference in VAS between 2 groups(P>0.05).There were no statistical differences in rate of reduction satisfaction and incidence of complication between 2 groups(P>0.05).Conclusions The primary debridement combined with external fixation and secondary sequential internal fixation for the treatment of Rüedi-AllgöwerⅡPilon fracture is conducive to the rapid recovery,which is worthy of extensive clinical promotion.